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From the Divisions of Neurology (Drs. Hershey, Bentti, and deGrauw, and S. LeCates) and Psychology (Dr. Powers), Children’s Hospital Medical Center, Cincinnati, OH.
Address correspondence and reprint requests to Dr. A.D. Hershey at Headache Center, Division of Neurology, Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039.
BACKGROUND: Chronic daily headaches (CDH) occur in >4% of the adult population. The criteria for CDH, however, are controversial. In children, the characterization of frequent headaches and CDH is limited.
METHODS: A Headache Center to characterize headaches in children (3 to 18 years old) was established. Over 34 months, 577 children have been evaluated. With use of a definition of 
15 headaches per month, 200 (34.6%) children had CDH.
RESULTS: The average age at the first headache in these children was 9.3 ± 3.6 years, whereas the average age at presentation to the Headache Center was 12.5 ± 3.1 years. Sixty-eight percent were girls, 88% were Caucasian, and 11% were African American. Ninety-two percent clinically had migraine headaches, whereas 60.5% met the International Headache Society migraine criteria. The pain was pulsatile in 79%, 63.5% had nausea with or without vomiting, and 59.5% had photophobia and phonophobia. Three subcategories emerged, with 37% having frequent headaches but not daily, 43.5% having episodic daily headaches, and 19.5% having a continuous headache.
CONCLUSION: The features of CDH in children most closely match those of migraine. A clear division of these children using frequency identifies three groups: frequent headaches (15 to 29), daily intermittent, and daily continuous. The daily continuous group is the most unique; however, the nature of these headaches continues to remain migrainous.
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